Hong M K, Mintz G S, Hong M K, Abizaid A S, Pichard A D, Satler L F, Kent K M, Leon M B
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 1999 Nov 1;84(9):992-8. doi: 10.1016/s0002-9149(99)00486-5.
Remodeling occurs in diseased human coronary arteries; however, reports of remodeling in diseased autologous saphenous vein bypass graft (SVG) stenoses are inconsistent. Preintervention intravascular ultrasound and quantitative coronary angiography were used to study 104 SVG stenoses in 93 consecutive patients. Lesion site and proximal and distal reference segment measurements included vein graft, external elastic membrane, lumen, wall (vein graft minus lumen), and plaque (external elastic membrane minus lumen) areas. Three indexes of remodeling were assessed: (1) lesion site SVG (or external elastic membrane) area was compared with the average reference segment, (2) SVG area was correlated with the wall area and external elastic membrane area was correlated with the plaque area, and (3) the impact of excess plaque accumulation (at the stenosis compared with the reference segment) on lumen compromise was calculated. Overall, the ratio of lesion/reference vein graft area was 1.07 +/- 0.25; however, 23 lesions were classified as negative remodeling (ratio <0.9), 37 as intermediate remodeling (ratio between 0.9 and 1.1), and 44 as positive remodeling (ratio >1.1). Reference segment vein graft area correlated with wall area (r = 0.906, p <0.0001), and external elastic membrane area correlated with plaque area (r = 0.703, p <0.0001). Similarly, lesion site vein graft area correlated with wall area (r = 0.978, p <0.0001), and external elastic membrane area correlated with plaque area (r = 0.961, p <0.0001). The regression line relating delta lumen area to delta wall area was y = -0.22 x - 6.2 (r = 0.451, p <0.0001) and the regression line relating delta lumen to delta plaque area was y = -0.47 x - 4.5 (r = 0.572, p <0.0001). (A slope of 0 would indicate perfect positive remodeling and a slope of 1.0 no positive remodeling.) Diseased SVGs undergo positive and negative remodeling similar to native coronary arteries.
重塑现象发生在病变的人类冠状动脉中；然而，关于病变自体大隐静脉旁路移植血管（SVG）狭窄处重塑的报道并不一致。采用干预前血管内超声和定量冠状动脉造影对93例连续患者的104处SVG狭窄进行研究。病变部位以及近端和远端参考节段的测量包括静脉移植物、外弹力膜、管腔、管壁（静脉移植物减去管腔）和斑块（外弹力膜减去管腔）面积。评估了三种重塑指标：（1）将病变部位的SVG（或外弹力膜）面积与平均参考节段进行比较，（2）SVG面积与管壁面积相关，外弹力膜面积与斑块面积相关，（3）计算过量斑块积聚（与参考节段相比在狭窄处）对管腔狭窄的影响。总体而言，病变/参考静脉移植物面积的比值为1.07±0.25；然而，23处病变被归类为负性重塑（比值<0.9），37处为中间重塑（比值在0.9和1.1之间），44处为正性重塑（比值>1.1）。参考节段静脉移植物面积与管壁面积相关（r = 0.906，p<0.0001），外弹力膜面积与斑块面积相关（r = 0.703，p<0.0001）。同样，病变部位静脉移植物面积与管壁面积相关（r = 0.978，p<0.0001），外弹力膜面积与斑块面积相关（r = 0.961，p<0.0001）。将管腔面积变化与管壁面积变化相关的回归线为y = -0.22x - 6.2（r = 0.451，p<0.0001），将管腔变化与斑块面积变化相关的回归线为y = -0.47x - 4.5（r = 0.572，p<0.0001）。（斜率为0表示完全正性重塑，斜率为1.0表示无正性重塑。）病变的SVG与天然冠状动脉一样经历正性和负性重塑。
